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Research round-up


 

In this story:

  • One in five prescriptions to seniors ‘inappropriate’
  • Survey confirms isolation of dementia
  • Thinking yourself healthy in older age
  • Getting creative with falls prevention
  • Collaborative study on dementia pain management underway
  • Flexible work options for older workers needed: study.
One in five prescriptions to seniors ‘inappropriate’

Weaning older patients off inappropriate medications that may harm them more than help them should be a priority for all prescribing clinicians, according to two articles published yesterday in the Medical Journal of Australia.

De-prescribing, the process of reducing or stopping drugs, “with the goal of minimising polypharmacy and improving outcomes”, has the potential to relieve unnecessary medication- related adverse events and disability in vulnerable older people, the authors wrote.

Associate Professor Ian Scott from the Department of Internal Medicine and Clinical Epidemiology at Princess Alexandra Hospital in Brisbane wrote that one in five prescriptions issued to older adults were “inappropriate”.

“One in four community-living older people are hospitalised for medication-related problems over a five-year period and 15 per cent of older patients attending general practice report an adverse drug event (ADE) over the previous six months,” wrote Professor Scott and colleagues.

At least a quarter of these ADEs are potentially preventable, they said.

“Up to 30 per cent of hospital admissions for patients over 75 years of age are medication-related, and up to three-quarters are potentially preventable.”

Research had shown that the single strongest predictor of inappropriate prescribing and increased risk of ADEs was the number of medications a person was taking, the authors said. “People in residential aged care facilities are prescribed, on average, seven drugs.”

They noted the barriers to de-prescribing included:

  • an under-appreciation of the extent of polypharmacy-related harms
  • increasing intensity of medical care and drug therapy
  • a too-narrow focus on inappropriate use of drugs whose benefits are mostly outweighed by harm but account for relatively few ADEs, while ignoring the fact that “commonly prescribed drugs with proven benefits in many older people. . . are more frequently implicated”
  • resistance of prescribers to discontinue medication, particularly that prescribed by specialists.

A second MJA article, by Dr Emily Reeve and her co-authors, from the University of South Australia, said that although evidence to date suggested de-prescribing would produce more benefits than risks, more research was desperately needed.

“More evidence is needed regarding negative, non-reversible effects of ceasing use of certain classes of medication,” Dr Reeve wrote.

Both articles concluded that most of the risks of de-prescribing could be minimised with proper planning.

Strong lines of communication between doctor and patient, targeting patients at highest risk of ADEs and drugs most likely to be non-beneficial, and consistency of care from one clinician over an extended period of time were also vital to the success of de-prescribing.

Survey confirms isolation of dementia

Social isolation is still one of the major issues associated with a diagnosis of dementia, according to a new report released today by Alzheimer’s Australia.

The report, Living with dementia in the community: challenges and opportunities, contains the results of the first nationwide survey of people with dementia to identify priorities for tackling stigma and social isolation associated with dementia.

The results indicated that dementia can have a devastating impact on the social lives of people with dementia, with more than a third of the survey respondents saying they wished they had more social contact with people in the community, and more than half stating that a fear of becoming lost is a major barrier to them going out and enjoying activities.

Speaking today at Parliament House, Graeme Samuel, national president of Alzheimer’s Australia, said that the best way of addressing the concerns of people with dementia was to consult them. “The report’s findings are concerning and confirm that the social isolation that results from dementia is alive and well,” he said.

“Almost half of those surveyed stated that they have difficulty communicating with staff in stores. This poses a huge problem for the 70 per cent of people with dementia who live in the community, and the 20 per cent of them who live alone.”

Click here for resources on dementia-friendly communities

Thinking yourself healthy in older age

A positive attitude can improve your immune system and may help you live longer, according to new research.

The University of Queensland study, published in Psychology and Aging, found that older people who focused on positive information were more likely to have stronger immune systems.

Lead researcher Dr Elise Kalokerinos, from UQ’s School of Psychology, said a positive attitude played an important role in healthy ageing.

The study followed 50 adults, aged 65-90 years, during two years. Participants were shown a series of positive and negative photos, which they were later asked to recall, and their immune function was also measured through a series of blood tests.

Dr Kalokerinos said participants who remembered more positive than negative images also showed better immune functioning up to two years later.

“We already know that happiness provides a range of health benefits and this research shows that focusing on positive information may have the same effect for older people… These findings raise the possibility that humans have evolved to become more positive late in life in order to enhance their own longevity,” she said.

Getting creative with falls prevention

Those aged over 65 who have had a fall before should balance on one leg to brush their teeth, bend their knees to pack the dishwasher and take stairs more often, according to researchers at the University of Sydney.

The exercises are part of the recently launched Lifestyle-Integrated Functional Exercise (LiFE) program, which was informed by a world-first study. This approach to exercise, described by the researchers as innovative and non-traditional, has been shown to reduce falls by over 30 per cent, by incorporating balance and strength training into everyday activities and daily routines.

Lead researcher Professor Lindy Clemson from the Faculty of Health Sciences said that bad balance and weak ankles and hips are the most common causes of falls in older people, but many people are reluctant to do any structured strength or balance training.

“What makes our program different is that we encourage people to get creative and do balance and lower limb strength activities whenever the opportunity arises throughout their day, such as sideways walking when hanging out the washing.”

The LiFE manuals are the result of research by Professor Clemson and colleagues published in the British Medical Journal.

They recruited 317 men and women over the age of 70, living at home, who suffered two or more falls in the past year. They compared those participating in the LIFE program to a control group doing a gentle ’placebo’ exercise program three times a week, and a third group who did traditional balance and strength exercises three times a week.

The researchers found a 31 per cent reduction in the rate of falls for participants in the LiFE program compared with the control group. LiFE participants also showed improvements in static and dynamic balance, ankle strength, and in function and participation in daily life, suggesting that the program improves both fall risk and frailty.

Collaborative study on dementia pain management underway

A new study is investigating the prevalence of, and clinical associations between, analgesic load, pain and daytime sedation in people with and without dementia living in Australian residential aged care facilities.

Aged services provider Resthaven is collaborating with researchers at Monash University on the research project.

Resthaven executive manager residential services, Tina Emery, said behavioural issues were sometimes managed inappropriately with psychotropic medicines, such as antipsychotics and sedatives, which in themselves could have adverse effects, including increased risk of falls and fractures.

“The findings of this study will be used to inform the development of strategies to improve the quality of life of people with dementia. Trained study nurses are currently undertaking data collection for the research at Resthaven,” she said.

The research project is funded by a Resthaven Research Scholarship that was awarded to Simon Bell, Associate Professor within the Faculty of Pharmacy and Pharmaceutical Sciences at Monash University.

The research aimed to develop new ways to alleviate suffering and behavioural symptoms associated with pain in people with dementia, who often experience and express pain differently, Ms Emery said.

Flexible work options for older workers needed: study

Mental illness and musculoskeletal injuries such as sprains and strains are the key reasons why older people drop out of the workforce, according to a new report.

The research by National Seniors Australia, Health conditions and employment among senior Australians, studied 2,000 people aged over 50 year to investigate the role of ill health in inhibiting workforce participation.

The report found that Australia’s mature age workforce participation rate could be improved if employers offered more flexible work options to help employees stay engaged in the workforce.

Some 46 per cent of people with an illness, injury or disability said ill health had prevented them from working, while 37 per cent could not work as many hours as they wanted, and 13 per cent said their ill health had prevented them from looking for work.

People with a musculoskeletal injury (61 per cent) and mental illness (58 per cent) were most likely to report that their illness had prevented them from working or looking for work, while arthritis kept people away from work for the longest period of time.

National Seniors research director Dr Tim Adair said Australia’s labour force participation was being hindered by the poor health of many older Australians.

Barriers to returning to work included a lack of support to change working conditions, lack of understanding by management, age discrimination and a lack of flexible work options.

Dr Adair said employers can help employees return to work by helping to manage preexisting health problems and implementing health programs for employees such as offering free health assessments and gym memberships.



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